开颅夹闭术治疗老年颅内破裂动脉瘤的近期疗效及其影响因素

目的 探讨开颅夹闭术治疗老年颅内破裂动脉瘤的近期疗效及其影响因素。方法 回顾性分析2014年1月至2017年10月行开颅夹闭术治疗的80例颅内破裂动脉瘤的临床资料。术后6个月采用GOS评分评价近期疗效，采用多因素Logistic回归分析影响近期预后的因素。结果 80例共83个动脉瘤，其中完全夹闭63个（75.90%）。术后发生脑血管痉挛3例、脑梗死3例、脑积水2例。术后6个月无复发，预后良好50例（62.50%，50/80；GOS评分4~5分）。多因素Logistic回归分析显示年龄>65岁、合并高血压、术前Hunt-Hess分级高是近期不良预后的独立危险因素（P<0.05）。结论 早期开颅夹闭术治疗老年颅内破裂动脉瘤近期疗效较好，年龄大、合并高血压及术前Hunt-Hess分级高是影响疗效的独立危险因素。

Short-term curative effect of craniotomy on elderly patients with ruptured intracranial aneurysm

Objective To analyze the short-term curative effect of craniotomy on the elderly patents with ruptured intracranial aneurysm. Methods The clinical data of 80 elderly patients with ruptured intracranial aneurysm, who underwent craniotomy for clipping the aneurysms in our hospital from January, 2014 to October, 2017, were analyzed retrospectively. The short-term curative effect was evaluated. The factors related to the short-term prognoses in the patients were analyzed by univariate and multivariate Logistic regression analysis. Results The operations were successful in all the patents. There were 83 intracranial aneurysms in these 80 patients. The rate of total clipping of the aneurysms and the occurrence of postoperative complications were 75.90% (63/83) and 10.00% (8/80),respectively. There was no recurrence of the aneurysm 6 months after the operation in all the patents. The rate of good prognosis was 62.50%. The univariate factor analysis showed that the factors related to the prognoses included age >65 years, hypertension and higher Hunt-Hess grade and CT Fisher grade (P<0.05). The multivariate logistic regression analysis showed that age >65 years, hypertension and preoperative high Hunt-Hess grade were independent risk factors related to the short-term prognoses in the patients with ruptured intracranial aneurysms undergoing craniotomy (P<0.05). Conclusions The short-term curative effects of early craniotomy on the elderly patients with ruptured intracranial aneurysm are good. Age>65 years, hypertension and preoperative high Hunt-Hess grade are independent risk factors influencing the curative effect in the patients with ruptured intracranial aneurysm undergoing the craniotomy.